Clinical Experiences of Venous Stent for Deep Vein Thrombosis in the Lower Extremity

PURPOSE: To evaluate the efficacy of venous stenting in the treatment of venous obstruction or stenosis of symptomatic deep vein thrombosis (DVT). METHOD: Eight consecutive patients with lower extremity DVT underwent venous stenting. The duration of symptoms were 20 days or less in 6 cases (acute) and above than 20 days in 2 cases (chronic). The cause of DVT was venous thrombophlebitis in 7 cases and extrinsic compression in 1 case. The indication of venous stenting is venous obstruction or stenosis after aspiration thrombectomy and direct catheter thrombolysis. The exclusion criteria were successful treatment of DVT with aspiration thrombectomy, direct catheter thrombolysis and percutaneous angioplasty. The follow-up examination was performed 1 week, 2~3 month interval by Doppler ultrasound, which was evaluated thrombi formation and patency of venous stenting. If the lesion detect in Doppler, second intervention was performed. RESULT: The venous stenting was successfully performed in all cases. Initial aspiration thrombectomy was performed in all cases. The urokinase was performed in 4 cases which was 500,000~750,000 IU (mean, 675,000) during from 2 to 8 hours (mean, 4). After that, the venous stenting was performed at the site of the venous occlusion and stenosis. The direct venography after stenting showed good reconstruction of vein and adequate restoration of venous flow. Seven patients relieved from lower extremity swelling without recurrence. One patient had re-thrombosis after venous stenting, which was successfully treated with percutaneous angioplasty. The follow-up duration was from 3 to 14 months (mean, 8 months). There were no thrombi in follow-up Doppler and normal regular life was resumed without lower extremity swelling. CONCLUSION: Venous stenting in the treatment of deep vein thrombosis is an effective and safe treatment method in the venous obstructive or stenotic remnant lesion despite following aspiration thrombectomy, direct catheter thrombolysis and percutaneous angioplasty.

Comparison of Lacrimal Scintigraphy and Contrast Dacryocystography in Epiphora

PURPOSE: Conventional contrast dacryocystography(C-DCG) has been used mainly for anatomical assessment of the lacrimal drainage apparatus, due to its limited information on the dynamics of the lacrimal system, and thus correlation role in epiphora. The purpose of study was to improve the diagnostic value in epiphora by utilizing RI dacryocystography(RI-DCG) with quantitative criteria. MATERIALS AND METHODS: The patient for RI dacryocystography set erect with the head fixed in front of gamma camera fitted with a standard 6 mm pinhole collimater. Both eyes of 85 patients(170 eyes) were scanned with 99rnTc-pertechnetate followed by conventional dacryocystography. The data from gamma camera were recorded simultaneously on a computer system for subsequent quantitative analysis. RESULTS: In 94 of 96 eyes without epiphora, RI-DCG was correlated with normal C-DCG and % of emptying was at least over 50%. In 58 of 74 eyes with epiphora, RI-DCG was correlated with abnormal C-DCG and % of emptying was at most below 50%. In 16 eyes with functional block, quantitative RI-DCG showed abnormal % of emptying. CONCLUSION: Nuclear DCG with quantitation had higher diagnostic yield in functional block and correlated higher with epiphora. Thus nuclear DCG with quantitation would be a valuable functional test after postprocedures such as dacryocystoplasty.

Therapeutic Efficacy of Percutaneous Cholecystostomy in Acute Acalculous Cholecystitis

PURPOSE: We evaluated the therapeutic efficacy and complications of percutaneous cholecystostomy in acalculou s acute cholecystitis. MATERIALS AND METHODS: We performed percutaneous cholecystostomy under ultrasound guidance for the treatment of 18 patients with acalculous acute cholecystitis. We retrospectively analyzed the therapeutic efficacy and complications. RESULTS: A dramatic improvement in clinical condition was observed in 16(88%) patients within 24 --48 hours. One patient was successfully treated with second trial because of technical failure at initial trial. No major complications occured except a gallbladder laceration. Most of patients complained minor symptoms such as fever, pain, mild dyspnea and refered pain to right shoulder, and these symptoms were resolved within one week. There was no complications related to vasovagal reflex. CONCLUSION: In the treatment of acalculous acute cholecystitis, percutaneous cholecystostomy is a safe and effective method.

Expandable metallic stents: An experimental study in the nasolacrimal system of dogs

Balloon dacryocystoplasty has been reported to be a safe, easy and effective nonoperative treatment for nasolacrimal stenosis. The results were not encouraging, however, because of its high failure and recurrence rates. To evaluate the feasibility of using modified Gianturco expandable metallic stents for maintenance of the dilated nasolacrimal system(NLS), 20 stents of 3 mm in diameter and 10mm long were placed in 20 nasolacrimal ducts of 10 dogs for 1 month to 10 months. It was more difficult to introduce the stents into the proximal portion(A) of the NLS than into the distal portion(B) due to the narrow and bony canal of the A portion. Twenty stents showed no migration in follow-up studies of up to 10 months. One complete occlusion occurred in a stent placed in A portion. Autopsy studies showed stents were covered with epithelium within 2 months after placement. Our experience suggest that the placement of Gianturco self-expandable stents may be a useful method of dilating and maintaining the luminal diameter of the NLS, although care must be taken to select the proper stent size.